Endovascular therapy and free flap transfer in chronic limb-threatening ischemia

Abstract

Although revascularization has evolved, treating foot gangrene with chronic limb-threatening ischemia remains challenging. There have been many reports on bypass surgery and free flap transfer. Meanwhile, few studies have reported on endovascular therapy and free flap transfer, with high flap survival rates and high wound complication rates. Wound complications are a serious problem that can lead to limb amputation, but previous studies have failed to identify risk factors for wound complications. In this study, we evaluated the results of endovascular therapy and free flap transfer for chronic limb-threatening ischemia and analyzed risk factors for wound complications. A total of 31 legs from 28 patients who underwent endovascular therapy and free flap transfer for lower limb salvage between August 2016 and April 2020 were retrospectively reviewed. The primary endpoints were flap survival and limb salvage rates and wound complication rates. In addition, we performed a statistical analysis of risk factors for wound complications. The flap survival rate was 100%, with partial necrosis in 6% of the patients. The limb salvage rate was 100%. The wound complication rate was 45%. The multivariate analysis showed end-stage renal failure on dialysis as a significant risk factor for wound complications (odds ratio = 133, 95% confidence interval = 2.74–6430, p = 0.014). Endovascular therapy and free flap transfer in chronic limb-threatening ischemia achieved high flap survival rate and limb salvage, but had a high incidence of wound complications. We identified end-stage renal failure on dialysis was a significant risk factor for wound complications.

Keywords:

• Free flap transfer
• endovascular therapy
• chronic limb-threatening ischemia
• risk factors
• wound complications

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

The authors thank Dr. Chihiro Shinkai, Dr. Haruno Miyazaki, and other members of our department for their cooperation in data collection and manuscript preparation. The authors would like to thank Enago for the English language review.

Author contribution

Conceived and designed the analysis: Shoichi Ishikawa and Shigeru Ichioka; Data collection: Shoichi Ishikawa, Kiyohito Arai, and Takeshi Kurihara; Contributed data/analysis tools: Shoichi Ishikawa, and Tomoya Sato; Performed the analysis: Shoichi Ishikawa and Tomoya Sato; Wrote the paper: Shoichi Ishikawa, and Shigeru Ichioka

Disclosure statement

No potential conflict of interest was reported by the author(s).